title: Endovascular aortic repair with the chimney technique using the ultra low-profile Ovation stent-graft for juxtarenal aneurysms having small iliac access vessels.
abstract: OBJECTIVE
  To report the first experience using the chimney technique in combination with the latest-generation low-profile stent-graft to seal abdominal aortic aneurysms having a very short neck (proximal sealing zone) and difficult access due to very small iliac vessels.
  
  
  METHODS
  Use of an ultra low-profile 14F delivery aortic stent-graft system (Ovation; Trivascular, Santa Rosa, CA) with chimneys to the lowermost renal arteries in two patients who were not anatomically suitable for endovascular aortic aneurysm repair (EVAR) and too frail for open surgery.
  
  
  RESULTS
  Implantation of stent-grafts and chimneys was technically successful without endoleak or other postinterventional complications. Follow-up after >1 year confirmed complete aneurysm exclusion, shrinkage of the aneurysm sac, and patent renal perfusion by way of the chimney.
  
  
  CONCLUSIONS
  Ultra low-profile aortic stent-graft systems are particularly helpful in case of inadequate small iliac access vessels and allow EVAR for short-necked aortic aneurysms if technical contraindications obviate FEVAR and physical impairment discourages open surgical repair.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg, Germany, alexander.massmann@uks.eu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Massmann
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Serracino-Inglott
authors.forename: Arno
authors.initials: A
authors.lastname: Buecker
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008875:Middle Aged; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012077:Renal Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012494:Sampling Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices